Etanercept: Een nieuwe behandelingsoptie voor psoriasis

In the pathogenesis of psoriasis there is a dominant role for activated T-cells and tumour necrosis factor (TNF). Recently, etanercept, a completely human recombinant fusion protein that binds both TNFα and TNFβ, was registered in Europe for treatment of moderate to severe plaque psoriasis. This biological is administered subcutaneously twice weekly in a dosage of 25 mg for a maximum period of 24 weeks. If there is a recurrence after cessation of treatment, patients can be retreated. After 24 weeks, over 45% of the patients have an improvement in PASI scores of at least 75%. On average, PASI values decrease by 65%. In 40% of the patients, the skin is clear or psoriasis is 'minimal' after 24 weeks. The quality of life increases considerably for the patients. Administration of the higher dose of 50 mg twice per week increases efficacy without added toxicity. The safety profile appears to be favourable. With the exception of injection site reactions, side effects in nature and frequency are largely similar to placebo. Serious adverse reactions causally related to etanercept are very infrequent. The place of etanercept in the treatment of moderate to severe plaque psoriasis has yet to be defined.